Mullerian adenosaroma of the cervix with sarcomatous overgrowth and heterologous elements presenting as a recurrent cervical polyp

Uterine cervical Müllerian adenosarcoma possibly arising from ovarian cystadenofibroma: A case report and review of the literature

Uterine cervical Müllerian adenosarcoma (MA), a rare malignant tumor of the female reproductive organs, is composed of a benign epithelium and a low-grade malignant stromal component. Because few studies have investigated the clinical management of MA, misdiagnosis often occur. Therefore, we proposed an optimal course of clinical management for patients with MA. MA is possibly a malignant transformation of the cystadenofibroma. In this study, we present a case of a 46-year-old woman who presented with symptoms of MA of the uterine cervix, such as metrorrhagia and a cyst in the cervical canals, after transvaginal excision of the left ovarian mucinous cystadenofibroma.

Post-radiation Mullerian adenosarcoma with sarcomatous overgrowth: rare presentation of an uncommon malignancy

Mullerian adenosarcoma is an uncommon biphasic malignant uterine tumor. It is composed of benign epithelial and malignant stromal elements. We present a case of a 45-year-old woman who presented with post-menopausal bleeding for three months. She had a significant past medical history of pelvic irradiation for squamous carcinoma of cervix 20 years ago. Pathology revealed adenosarcoma with sarcomatous overgrowth. The patient had a recurrence of pure sarcoma three months later and unfortunately succumbed to her disease. The role of radiation in the pathogenesis of adenosarcoma has been uncommonly described compared to its well established role in the development of carcinosarcoma. Our case fulfils the criteria for a radiation induced sarcoma. We review the salient clinical and pathological features of this uncommon lesion highlighting the importance of sarcomatous overgrowth in these lesions and the possible role of radiation in the development of these tumors.

Ovarian metastasis of Müllerian adenosarcoma of the cervix with sarcomatous overgrowth

The aim of this study is to present a rare case of Müllerian adenosarcoma of the cervix with ovarian metastasis and sarcomatous overgrowth. A gravida 2, para 2 woman aged 32 years with vaginal bleeding was admitted to the gynecology department. A 3-4 cm polypoid mass protruding from the cervix was detected in a pelvic examination. Total abdominal hysterectomy and bilateral salpingoopherectomy was performed because of metastatic implants on the right ovary. The pathologic evaluation revealed Müllerian adenosarcoma of the cervix with sarcomatous overgrowth and ovarian metastasis. After surgery, the patient was planned to undergo chemo- and radiotherapy. This is the first cervical Müllerian adenosarcoma case mentioned in the literature with metastasis to the ovary in a young woman. There is no optimal management option for cervical adenosarcomas due to the rarity of this phenomenon. Nevertheless, even if the patient is young and imaging techniques do not elucidate metastatic disease, surgeons should evaluate the ovaries for the spread of tumor, especially if histology reveals sarcomatous overgrowth.

Uterine Adenosarcoma: a Review

Adenosarcomas are rare malignancies of the female genital tract, accounting for approximately 5 % of uterine sarcomas. Occasionally, adenosarcoma occurs in the ovaries or in extra-uterine tissue, which may be related to endometriosis. These tumors are characterized by benign epithelial elements and a malignant mesenchymal component. Pathologic diagnosis is dependent on the identification of the characteristic morphologic features. The most common immunohistochemical markers for adenosarcoma are CD10 and WT1, but these are not specific. The most frequent presenting symptom is abnormal uterine bleeding. The majority of patients present with stage I disease, with a 5-year overall survival of 60 to 80 %. Survival is influenced by the presence of myometrial invasion, sarcomatous overgrowth, lymphovascular invasion, necrosis, and the presence of heterologous elements including rhabdomyoblastic differentiation. Patients with sarcomatous overgrowth have significantly increased risk of recurrence 23 versus 77 % and decreased 5-year overall survival 50 to 60 %. Standard of care treatment is total hysterectomy with bilateral salpingo-oophorectomy without lymphadenectomy, as the incidence of lymph node metastasis is rare. Retrospective data does not support the use of adjuvant pelvic radiotherapy in uterine adenosarcomas as no survival benefit is seen. Insufficient data exists to recommend routinely neoadjuvant or adjuvant chemotherapy for uterine adenosarcomas. Limited evidence exists for the role of hormonal therapy in uterine adenosarcomas. The PIK3/AKT/PTEN pathway is mutated in ∼70 % of adenosarcomas, and this may represent a possible therapeutic target. This article reviews the current state of knowledge concerning uterine adenosarcoma and discusses the management of this rare tumor.

Case Report of Successful Childbearing after Conservative Surgery for Cervical Mullerian Adenosarcoma

Mullerian adenosarcoma (MA) is a rare tumor variant with low malignancy potential and is reported to account for 8% of all uterine sarcomas. Cervical MAs are reported to occur in relatively younger patients with the mean age of 27 years, while those in the uterine corpus generally present in postmenopausal women. Due to the rarity of cervical MAs, optimal management for these patients (especially younger women) is still under exploration. Here, we describe a case of cervical MA in a woman of reproductive age who was treated by fertility-preserving surgery and successfully delivered a child 18 months later.

Müllerian adenosarcoma of the uterine cervix with sarcomatous overgrowth: A case report of aggressive disease in a young patient

•

Cervical Müllerian adenosarcomas with sarcomatous overgrowth are rare and aggressive.

•

Recurrence is more likely when less radical surgery is performed.

•

Radiotherapy and ifosfamide and platinum chemotherapy may aid disease control.

Introduction

Müllerian adenosarcoma of the cervix with sarcomatous overgrowth and lymphovascular invasion is a rare and aggressive disease. We report a case of a young patient with Müllerian adenosarcoma with sarcomatous overgrowth in the uterine cervix and pelvic lymph node involvement. The patient received radical surgery but not adjuvant treatment, and the disease was aggressive with rapid relapse.

Presentation of case

A 39-year-old woman was diagnosed with Müllerian adenosarcoma of the cervix with sarcomatous overgrowth, International Federation of Gynecology and Obstetrics (FIGO) stage IB2. She underwent abdominal radical hysterectomy and resection of the left external iliac lymph nodes for suspected metastatic involvement detected during surgical exploration but undetected via imaging. She refused adjuvant treatment, and the disease recurred 8 months after primary oncologic surgery, with rapid local, regional, and bone relapse.

Discussion

Our report suggests that sarcomatous overgrowth, a high mitotic index, a rhabdomyoblastic component, and lymphovascular compromise are risk factors for aggressive recurrence. Positron emission tomography-computed tomography (PET-CT) was used to identify relapse locations in addition to those detected via clinical examination of the vaginal vault. However, whether PET-CT is indicated for the initial detection of lymph node and bone metastases in FIGO stage IB tumors with surgical indication is unclear.

Conclusion

A young woman with Müllerian adenosarcoma of the cervix with sarcomatous overgrowth presenting the risk factors for its recurrence experienced a rapid relapse after receiving radical surgery but not adjuvant therapy. Control of this aggressive disease via sequential radiotherapy and chemotherapy are recommended.